tbuckley/cabot-search huggingface dataset:
Abstract 12533: Heart Failure Diagnostic Classification Criteria in Hospitalized Patients Are Associated With Increased Mortality Risk: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Oludamilola A Aladesanmi, Laura Loehr, Wayne D Rosamond, Quefeng Li, Joseph Rossi, Michael E Hall, Patricia Chang
Journal: Circulation (2023)

Introduction: Multiple diagnostic HF classification have been used to identify heart failure (HF) events. Whether these classification criteria can be used for estimating prognosis is unknown. Research Question: This study compares multiple research-derived HF classification criteria for predicting mortality in the ARIC study cohort with validated hospitalized acute decompensated heart failure (ADHF) events. Methods: There were 1,954 ARIC cohort members with hospitalized HF events from 2005-2019, validated as ADHF by ARIC study classification/adjudication. These HF events were also classified as HF present/absent at the time of hospitalization by other HF classification criteria - Framingham, Modified Boston, NHANES, and Gothenburg. Hazard ratios (HRs) for all-cause mortality at 30 days, 1 year, and 5 years were calculated using logistic regression for all included HF classification criteria compared to ARIC, stratified by ejection fraction (EF), and adjusted for demographics and comorbidities. Results: For all ADHF events, Framingham, NHANES, and Gothenburg were prognostic for survival, but not modified Boston criteria (Table). ADHF patients who were also classified as HF by Framingham criteria had a 30% or more increased mortality at 30-day, 1-year, and 5-years regardless of EF, compared to those who were not classified as HF by Framingham (p&lt;0.05). Framingham criteria were prognostic for 30-day survival for those with HFrEF, and also for 1-year and 5-year survival for those with HFpEF. Conclusion: The presence of HF as defined using different published criteria is associated with elevated risk of all-cause mortality. To our knowledge, this is a novel study comparing multiple research-derived HF classification criteria for clinical prognostication of mortality in ADHF. More studies are needed to assess the utility of these HF classification criteria for prognostication for HF morbidity and rehospitalization and by HF type.
Abstract 19130: Is Early Hospital Discharge Safe After Adult Heart Transplantation?
Authors: Khaled Shorbaji, Jennie Kwon, Brett Welch, Delgaizo John, Arman Kilic
Journal: Circulation (2023)

Introduction: The impact of early hospital discharge (EHD) after adult heart transplantation (HT) on longitudinal outcomes is unclear. Many HT recipients are intentionally kept in the hospital for extended stays for continued clinical monitoring. However, there is growing interest in implementing EHD protocols and initiatives to improve patient throughput, optimize hospital resources and bed capacity, and reduce costs. Hypothesis: This study evaluated the impact of EHD on HT outcomes. Methods: The United Network for Organ Sharing (UNOS) database was utilized to identify adult (≥ 18 years old) HT recipients surviving to hospital discharge between January 2010 and December 2022. EHD was defined as occurring within 7 days of HT. Kaplan-Meier analysis was used to estimate survival probability of EHD recipients at 30-days, 90-days, 1-year, 1-year conditional on 30-day survival and 1-year conditional on 90-day survival. Multivariable Cox regression was used for risk adjustment. Results: Of the 31,638 total HTs performed in the study period, 30,720 (97.1%) survived to hospital discharge of which 1,033 (3.36%) were classified as EHD. In an unadjusted analysis, HT recipients survival rates were: [(30-days: ED 99.5% vs non-EHD 98.4%, log-rank p= 0.004), (90-days: EHD 98.8% vs non-EHD 96.4%, log-rank p&lt; 0.001), (1-year: EHD 96.5% vs non-EHD 92.9%, log-rank p&lt; 0.001), (1-year conditional on 30-day survival: EHD 96.9% vs non-EHD 94.5%, log-rank p&lt; 0.001), and (1-year conditional on 90-day survival: EHD 97.6% vs non-EHD 96.4%, log-rank p= 0.036)] (Figure 1). After risk adjustment, the Hazard Ratio (HR) of mortality for EHD recipients was: [30-days HR: 0.37 (0.15-0.89, p=0.027), 90-days HR: 0.39 (0.22-0.70, p=0.001), 1-year HR: 0.57 (0.39-0.82, p=0.003), 1-year conditional on 30-day survival HR: 0.60 (0.40-0.90, p=0.013), and 1-year conditional on 90-day survival HR: 0.75 (0.47-1.18, p=0.213)]. Conclusions: HT patients with EHD have lower complication rates than non-EHD patients. Although a minority of patients have EHD after HT, these data suggest it can be done safely with excellent longitudinal outcomes. Efforts to share best practices and protocols allowing for EHD may be prudent to broadening this practice nationwide in appropriate cases.
Abstract 16940: Nutrient Intake of Patients With Heart Failure: Different Profiles Reveal Different Intervention Targets
Authors: Jessica H Thompson, Martha J Biddle, Christopher S Lee, Terry A Lennie, JungHee Kang, Debra K Moser
Journal: Circulation (2023)

Introduction: Diet quality is an important, but often underappreciated part of heart failure (HF) care. Tailoring of dietary interventions must take into consideration how patients with HF eat. Purpose: To identify distinct dietary profiles representing eating patterns in patients with HF. Methods: This was a secondary analysis of data from a randomized controlled double-blind clinical trial of a nutrition intervention with patients with HF. Baseline dietary data were collected using 24-hour dietary recall that included a weekend and two weekdays. Nutritional data were generated from the Nutrition Data Systems for Research. Nine unique diet components were quantified (along with a total Healthy Eating Index) and included in modeling based on theoretical and empirical knowledge: sodium, added sugars, trans-fat, vitamin C, vitamin D, vitamin E, folate, beta-cryptoxanthin, and lutein + zeaxanthin. Latent class mixture modeling was used to identify distinct dietary profiles among these 9 components representing different eating patterns that could serve as the bases of future interventions. Results: There were 112 participants with an average age 63 ± 12, 59.8% male, and 62.5% with class III or IV HF. Two dietary profiles were identified and were labeled by the prominent dimensional characteristic. The “higher intake” profile (n=79 (69.9% of the sample)) had significantly higher intake levels of sodium, vitamin D, vitamin E, vitamin C, beta-cryptoxanthin, lutein + zeaxanthin, and folate, and a “lower intake” profile (n=34 (30.1% of the sample) had significantly lower intake of these same nutrients. Patients with HF in the lower intake profile also had significant higher quality diets (Healthy Eating Index = 63.7± 13.2) compared with those in the higher intake profile (Healthy Eating Index = 53.9 ± 14.2, p&lt;0.001). Conclusion: Two different nutrient patterns were identified that would be amenable to different interventions; one focused on total calorie reduction and the other focused on optimizing nutrient intake.
Abstract 13865: Home Monitoring and Unanticipated Interstage Readmissions: Evaluating the Impact of Neighborhood Social Vulnerability
Authors: Rachel J Shustak, Jen Faerber, Alyson Stagg, Chitra Ravishankar, Laura Mercer-Rosa, Therese M Giglia, Monique M Gardner
Journal: Circulation (2023)

Introduction: Unanticipated interstage (IS) readmissions are common in infants with hypoplastic left heart syndrome (HLHS). Enrollment in our center’s Infant Single Ventricle Management and Monitoring Program (ISVMP) has been associated with increased readmission frequency. We examined the impact of neighborhood social vulnerability on the association of ISVMP with readmission frequency and cumulative readmission days. We hypothesized that greater social vulnerability was associated with greater risk for readmission. Methods: We performed a retrospective single-center cohort study comparing infants with HLHS enrolled in ISVMP (12/2010-12/2019) to historical controls (01/2007-11/2010). Outcomes were number of readmissions per IS days and cumulative IS readmission days. Neighborhood social vulnerability was measured by the Centers for Disease Control Social Vulnerability Index (SVI). High SVI signifies greater vulnerability. Negative binomial regression models were used to examine the association between ISVMP, SVI tertiles, and the outcomes. Models were adjusted for demographic, operative, and discharge characteristics. Results: We evaluated 328 infants with HLHS; 198 ISVMP infants and 128 historical controls. The association of ISVMP and IS readmissions strengthened as social vulnerability increased. ISVMP was not associated with IS readmissions in low SVI infants (IRR 1.55; 95% CI 0.94, 2.54). However, middle and high SVI infants enrolled in ISVMP were significantly more likely to be readmitted than their historical counterparts (middle SVI: IRR 1.67; 95% CI 1.01, 2.76; high SVI: IRR 2.14; 95% CI 1.33, 3.45). On stratified analysis, there was no relationship between SVI tertile and cumulative IS readmission days in the historical controls. However, in the ISVMP cohort, high SVI infants had 70% more cumulative readmission days compared to their middle SVI peers (IRR 1.69; 95% CI 1.11, 2.59). Conclusions: High social vulnerability infants with HLHS enrolled in ISVMP are at high risk for IS readmission compared to their historical, middle and low vulnerability peers. Future efforts should focus on understanding whether these findings are due to disparities in IS medical complexity, illness severity, or readmission criteria.
Abstract 13857: Slit2/ROBO4 Ligand-Receptor Pair as Novel Biomarkers for Survival in Pulmonary Arterial Hypertension
Authors: Carly Blatt, Jun Yang, Allan Barnes, Megan Griffiths, Rachel L Damico, Catherine Simpson, Todd Kolb, Michael Pauciulo, Bill Nichols, Dunbar D Ivy, Eric D Austin, Paul Hassoun, Allen D Everett
Journal: Circulation (2023)

Background: Slit ligand guidance 2 (Slit2) is a ligand of the Roundabout guidance receptor (ROBO4), a transmembrane endothelial-specific receptor expressed in lung tissue. Pulmonary vascular remodeling contributes to PAH development and ROBO4 has been shown to play a role in inhibiting VEGF related angiogenesis. No studies have evaluated ROBO4 and Slit2 levels in PAH. Research Question: This study sought to assess if ROBO4 and/or Slit2 levels are detectable, altered in and associated with survival outcomes and hemodynamic measurements in patients with PAH. Methods: Serum ROBO4 levels were measured in 139 adults with PAH and 90 controls. Serum Slit2 levels were measured in 210 adults with PAH and 40 controls. Mann-Whitney U tests were used to compare biomarker levels in PAH and controls. Biomarker levels in the PAH cohort were compared to hemodynamic measurements and survival analyses were conducted for a composite outcome (death or transplant) using Cox proportional hazard models, and Kaplan Meier analysis with biomarkers dichotomized at the median. Results: ROBO4 and Slit2 levels were higher in PAH vs control patients (p=0.0005, p=0.002). In Kaplan-Meier analysis, ROBO4 and Slit2 levels above the median were associated with time to death or transplant (Logrank test p=0.016, p=0.03). ROBO4 and Slit2 levels were positively associated with death or transplant using Cox proportional regression, adjusted for age with a hazard ratio of 1.8 (95% CI 1.07-2.97, p=0.003) and 1.49 (95% CI 1.11-1.99, p=0.008), respectively. There were no statistically significant associations between ROBO4 and Slit2 levels and hemodynamic data such as mPAP, mRAP and PVR. Conclusions: This pilot data demonstrates that the angiogenic protein Slit2 and its receptor ROBO4 levels are both associated with survival outcomes in PAH. Future studies should evaluate in vitro studies to localize Slit2/ROBO4 in lung tissue using immunohistochemistry.
Abstract 13877: Podoplanin Positive Cell-Derived Extracellulatr Vesicles as Novel Mediators of Cardiac Amyloidosis After Myocardial Infarction
Authors: Maria Cimini, Cagla Tukel, Ulrich H.E. Hansmann, Carolina Gonzalez, Andrew Chesney, May Truongcao, Chunlin Wang, Erhe Gao, Tao Wang, Rajika Roy, Anna Maria Lucchese, Vandana Mallaredy, Charan T Gurrala, Ajit Magadum, Darukeshwara Joladarashi, Cindy Benedict, Walter J Koch, Raj Kishore
Journal: Circulation (2023)

Amyloidosis represent a major long-term complication of myocardial infarction (MI);however, the exact mechanisms of post-MI cardiac amyloidosis are yet to be fullyunderstood. Onset of amyloid fibers deposition alongside with extra-cellular-matrix (ECM)proteins in the ischemic tissue exacerbates rigidity and stiffness of the scar hindering thecontractility of viable myocardium in the left ventricle. Amyloid proteins, at the site of injury, are released after inflammation mostly by activated immune cells and mesenchymalstomal cells. We have reported earlier that two days after MI, a cohort of mesenchymalstromal cells begin to de novo express Podoplanin (PDPN), a platelet aggregation-inducing type I transmembrane glycoprotein, as a sign of activation. PDPN acquisitionallows mesenchymal stromal cells to communicate with macrophages bearing PDPNreceptor, a C-type lectin-like receptor 2 (CLEC-2). Here we show that in addition to cell-to-cell contact, Podoplanin positive cells (PDPN+ cells) further activate macrophagesthrough their extracellular vesicles or exosomes. Specifically, PDPN+ cells derivedexosomes deliver Serum Amyloid A 3 (SAA3) protein that, after binding to Toll-likereceptor 2 (TRL2) on macrophages, triggers an overproduction of SAA3 in macrophages,with consequent impaired clearance of SAA3. Saturated lysosomes release SAA3protofilaments that are prone to misfold and aggregate as extracellular, insoluble, andrigid amyloid deposits leading to cardiac amyloidosis. We show that injection of exosomesfrom PDPN+ mesenchymal stromal cells induce infiltrating fibrosis, SAA3 deposition anddepressed cardiac function in healthy mouse hearts. Using SAA3 and TLR loss-of-function mouse models we show that SAA3 delivered by PDPN+ cell exosomes have alocal function in promoting post-MI amyloidosis. In vivo administration of newly developedD-peptide inhibits the aggregation of misfolded SAA3 with consequent scar stiffnessreduction and positive modulation of the ischemic heart function. In addition to providingnew mechanistic insights into post-MI amyloidosis, our findings suggest that SAA3 maybe an attractive target for effective scar reversal after ischemic injury.
Abstract 12508: Association Between Statin Use and Chemotherapy Induced Cardiac Dysfunction Among Cancer Patients: A Meta-Analysis
Authors: Vikash Jaiswal, Song Peng Ang, Novonil Deb, Endurance O Evbayekha, Vibhor Agrawal, Akash Jaiswal
Journal: Circulation (2023)

Background: Chemotherapy-induced cardiac dysfunction (CICD) is a significant and concerning complication observed among cancer patients. Despite the demonstrated cardioprotective benefits of statins in various cardiovascular diseases, their effectiveness in mitigating CICD remains uncertain. Objective: This meta-analysis aims to comprehensively evaluate the potential cardioprotective role of statins in patients with CICD. Methods: A comprehensive systematic literature search was conducted using PubMed, Embase, and Scopus databases to identify relevant articles published from inception until 10th May 2023. The outcomes were assessed using pooled Odds Ratio (OR) for categorical data and Mean Difference (MD) for continuous data, with corresponding 95% confidence intervals (95% CI). Results: The meta-analysis comprised 8 studies involving a total of 5,232 patients, with 1,754 in the statin group and 3,478 in the control group. The study findings demonstrated a significant difference in left ventricular ejection fraction (LVEF) at the study's conclusion, with the control group exhibiting a substantially lower LVEF compared to the statin group (MD: 2.08, 95% CI: 0.86, 3.30; p &lt; 0.001). Furthermore, the change in LVEF from baseline was also significant, with the control group demonstrating a greater decrease compared to the statin group (MD: 4.01, 95% CI: 0.84, 7.18; p= 0.01). Additionally, the statin group exhibited a notable reduction in the likelihood of heart failure compared to the control group (OR: 0.41, 95% CI: 0.27-0.62; p&lt; 0.001). However, no statistically significant distinction in left ventricular end-diastolic volume was observed between the groups (MD: 1.55, 95% CI: -5.22, 8.33, p = 0.65). Conclusion: The results of this meta-analysis indicate that statin therapy may offer cardioprotective benefits for patients with CICD, improving left ventricular function and reducing the risk of heart failure.
Abstract 15616: Decline in Temporal Trends of Medicare Physician Reimbursement for Cardiovascular Procedures
Authors: Kannu Bansal, Bharat Rawlley, Nihar R Desai, Robert W Yeh, Dhaval S Kolte
Journal: Circulation (2023)

Introduction: Utilization of cardiac procedures are common among Medicare beneficiaries and projected to increase over time. Temporal trends of physician fee reimbursement for CV procedures have not been studied. Methods: Cross-sectional study was conducted for national payment amounts that were extracted from Centers for Medicare &amp; Medicaid Services (CMS) Physician Fee Schedule Look-Up Tool using Current Procedural Terminology (CPT) codes. Study time period ranged from 2013 through 2023. CPT codes were analyzed for coronary (percutaneous coronary intervention, coronary artery bypass graft), valvular (surgical aortic, mitral, tricuspid repair/replacement), and structural (transcatheter aortic valve replacement, mitral transcatheter edge-to-edge repair, left atrial appendage occlusion) procedures. All prices were adjusted for inflation to January 2023 US dollars. Primary outcomes were unadjusted and adjusted mean percentage changes (annual and total over 10-year period) and compound annual growth rates for each CV procedure. Results: From 2013 to 2023, mean total unadjusted percentage changes ranged from -0.54% to -21.78%; which decreased further after adjusting for inflation, ranging from -21.07% to -39.83%. The decline was seen in all studied CV procedures. Annual rates (mean and compound) were -3% for most procedures after adjusting for inflation. Conclusions: Our findings suggest a declining trend in physician reimbursement for CV procedures by Medicare, which may adversely influence access to procedures, affect commercial insurance pricing/coverage, and inform trainees and practicing CV physicians of current financial situation. Emphasis needs to be placed on value-based payment model for sustainable and efficient CV care.
Abstract 15619: Prevalence of Transthyretin Cardiac Amyloidosis in Elderly Subjects From the General Population: The Catch Study
Authors: Alberto Aimo, Vincenzo Castiglione, Andrea Barison, IACOPO FABIANI, Giorgia Panichella, Assuero Giorgetti, Dario Genovesi, Maria Franzini, Stefano Moscardini, Claudio Passino, Giuseppe Vergaro, Michele Emdin
Journal: Circulation (2023)

Introduction: The exact prevalence of transthyretin cardiac amyloidosis (ATTR-CA) in the general population has never been defined. Methods: We conducted a population screening in an area of Tuscany (Italy) where there is no cluster of variant ATTR. Six general practitioners proposed study participation to a total of 2,566 subjects aged ≥65 years, with 1,000 accepting. All subjects underwent first-line exams searching the following elements of suspicion of CA: high sensitivity-troponin T ≥14 ng/L, interventricular septal thickness ≥12 mm, any echocardiographic, ECG or clinical red flag. Individuals with any of these elements were referred to the search for a monoclonal protein and bone scintigraphy. Results: Step two exams (bone scintigraphy and search for a monoclonal protein) were proposed to 346 subjects, and 216 (62%) accepted. Three patients were ultimately diagnosed with ATTR-CA (a 79-year-old woman, an 85-year-old and a 74-year-old man), and the diagnosis was deemed likely in another patient (an 83-year-old woman with mild bone tracer uptake but intense uptake in the inferior wall, not willing to undergo endomyocardial biopsy). No patient had a monoclonal protein nor TTR gene mutations. All patients with ATTR-CA had left ventricular wall thickening and complained of dyspnea on moderate effort. The prevalence of ATTR-CA was 3 out of 870 (654 [Step two not proposed] + 216 [Step two performed]) = 0.34%, or 0.46% if considering also the fourth case. Conclusions: The prevalence of wild-type ATTR-CA in the elderly population is 0.34% (established diagnoses) or 0.46% (established or likely diagnoses).
Abstract 16938: Epicardial Adipose Tissue on the Risk of Lethal Ventricular Arrhythmias in Patients With Nonischemic Cardiomyopathy Receiving Implantable Cardioverter-Defibrillator
Authors: Shiro Nakamori, Forough Yazdanian, Jennifer Rodriguez, Jennifer Yue, Jordan Street, Daniel B Kramer, Long H Ngo, Warren J Manning, Reza Nezafat
Journal: Circulation (2023)

Background: The arrhythmic risk stratification in patients with nonischemic cardiomyopathy (NICM) remains challenging. The implication of epicardial adipose tissue (EAT) on incident sudden cardiac death (SCD) is unclear. Objectives: To assess the relationship between EAT and SCD in NICM patients receiving implantable cardioverter-defibrillators (ICD) and compare this risk to patients with ischemic cardiomyopathy (ICM). Methods: A total of 421 patients scheduled for primary or secondary prevention ICD implantation underwent CMR at 1.5 or 3T, including cine and late gadolinium enhancement (LGE) imaging. EAT volume surrounding both ventricles was quantified with manual delineation on cine short-axis images and calculated by summation of EAT volume of each slice using the modified Simpson rule. LGE was semiautomatically quantified by adjusting a grayscale threshold. The primary endpoint was a composite of ICD therapy, including anti-tachycardia pacing and SCD. Results: We identified 265 NICM patients (mean age 54 years, 73% men), with LGE present in 152 patients (57%), including 85 patients (32%) with secondary prevention ICD. During the median follow-up of 2.9 years, 42 patients (16%) experienced the endpoint. Low EAT was associated with an increased risk of SCD in NICM patients (HR ad per 10ml decrease, 1.54; 95%CI, 1.19-1.96, p&lt;0.001), even after adjustment for other relevant disease variables. A continuous relationship was evident between EAT and subsequent ICD therapies (p=0.001). Even when considering 85 patients with secondary prevention ICD as theoretically having an SCD event, the risk of EAT in predicting SCD remained essentially unchanged. In contrast, EAT was not associated with increased SCD risk in ICM patients. Conclusions: Low EAT was associated with increased SCD risk in NICM patients receiving ICD implantation, especially primary prevention ICD. These data suggest a potential role of EAT in identifying NICM patients at risk of SCD.